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Paradossi U, De Caterina AR, Trimarchi G, Pizzino F, Bastiani L, Dossi F, Raccis M, Bianchi G, Palmieri C, de Gregorio C, Andò G, Berti S. The enigma of the 'smoker's paradox': Results from a single-center registry of patients with STEMI undergoing primary percutaneous coronary intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00537-2. [PMID: 38862370 DOI: 10.1016/j.carrev.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Smoker's paradox usually refers to the observation of a favorable outcome of smoking patients in acute myocardial infarction. METHODS From April 2006 to December 2018 a population of 2456 patients with ST segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI) were prospectively enrolled in the MATRIX registry. Ischemic time, clinical, demographics, angiographic data, and 1-year follow-up were collected. RESULTS Among 2546 patients admitted with STEMI, 1007 (41 %) were current smokers. Smokers were 10 years younger and had lower crude in-hospital and 1-year mortality (1.5 % vs 6 %, p < 0.0001 and 5 % vs 11 %, p < 0.0001), shorter ischemic time (203 [147-299] vs 220 [154-334] minutes, p = 0.002) and shorter decision time (60 [30-135] vs 70 [36-170] minutes, p = 0.0063). Smoking habit [OR:0.37(95 % CI:0.18-0.75)-p < 0.01], younger age [OR 1.06 (95%CI:1.04-1.09)-p < 0.001] and shorter ischemic time [OR:1.01(95%CI:1.01-1.02)-p < 0.05] were associated to lower in-hospital mortality. Only smoking habit [HR:0.65(95 % CI: 0.44-0.9)-p = 0.03] and younger age [HR:1.08 (95%CI:1.06-1.09)-p < 0.001] were also independently associated to lower all-cause death at 1-year follow-up. After propensity matching, age, cardiogenic shock and TIMI flow <3 were associated with in-hospital mortality, while smoking habit was still associated with reduced mortality. Smoking was also associated with reduced mortality at 1-year follow-up (HR 0.54, 95 % CI [0.37-0.78]; p < 0.001). CONCLUSIONS Smoking patients show better outcome after PCI for STEMI at 1-year follow-up. Although "Smoking paradox" could be explained by younger age of patients, other factors may have a role in the explanation of the phenomenon.
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Affiliation(s)
- Umberto Paradossi
- Fondazione Toscana G. Monasterio, Ospedale del Cuore, 54100 Massa, Italy
| | | | - Giancarlo Trimarchi
- Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
| | - Fausto Pizzino
- Fondazione Toscana G. Monasterio, Ospedale del Cuore, 54100 Massa, Italy
| | - Luca Bastiani
- Fondazione Toscana G. Monasterio, Ospedale del Cuore, 54100 Massa, Italy
| | - Filippo Dossi
- Department of Cardiology, Ospedale di Lavagna, 16033 Lavagna, Italy
| | - Mario Raccis
- Department of Cardiology, Ospedale di Lavagna, 16033 Lavagna, Italy
| | - Giacomo Bianchi
- Fondazione Toscana G. Monasterio, Ospedale del Cuore, 54100 Massa, Italy
| | - Cataldo Palmieri
- Fondazione Toscana G. Monasterio, Ospedale del Cuore, 54100 Massa, Italy
| | - Cesare de Gregorio
- Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
| | - Giuseppe Andò
- Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy.
| | - Sergio Berti
- Fondazione Toscana G. Monasterio, Ospedale del Cuore, 54100 Massa, Italy
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Irie F, Matsuo R, Mezuki S, Wakisaka Y, Kamouchi M, Kitazono T, Ago T. Effect of smoking status on clinical outcomes after reperfusion therapy for acute ischemic stroke. Sci Rep 2024; 14:9290. [PMID: 38654009 PMCID: PMC11039615 DOI: 10.1038/s41598-024-59508-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
Smoking has detrimental effects on the cardiovascular system; however, some studies have reported better clinical outcomes after thrombolysis for ischemic stroke in smokers than in nonsmokers, a phenomenon known as the smoking paradox. Therefore, this study aimed to examine the smoking paradox in patients with ischemic stroke receiving reperfusion therapy. Data were collected from a multicenter hospital-based acute stroke registry in Fukuoka, Japan. The 1148 study patients were categorized into current and noncurrent smokers. The association between smoking and clinical outcomes, including neurological improvement (≥ 4-point decrease in the National Institutes of Health Stroke Scale during hospitalization or 0 points at discharge) and good functional outcomes (modified Rankin Scale score of 0-2) at 3 months, was evaluated using logistic regression analysis and propensity score-matched analysis. Among the participants, 231 (20.1%) were current smokers. The odds ratios (ORs) of favorable outcomes after adjusting for potential confounders were not significantly increased in current smokers (OR 0.85, 95% confidence interval [CI] 0.60-1.22 for neurological improvement; OR 0.95, 95% CI 0.65-1.38 for good functional outcome). No significant association was found in the propensity score-matched cohorts. Smoking cessation is strongly recommended since current smoking was not associated with better outcomes after reperfusion therapy.
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Affiliation(s)
- Fumi Irie
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Ryu Matsuo
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.
| | - Satomi Mezuki
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
- Emergency and Clinical Care Center, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Yoshinobu Wakisaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Masahiro Kamouchi
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Tetsuro Ago
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
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Li J, Zuo Y, Feng L, Cai YS, Su J, Tong Z, Liang L. Association of blood eosinophils with corticosteroid treatment failure stratified by smoking status among inpatients with AECOPD. BMJ Open Respir Res 2024; 11:e001634. [PMID: 38609180 PMCID: PMC11029211 DOI: 10.1136/bmjresp-2023-001634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Recent studies have suggested elevated blood eosinophils are independent predictors of response to corticosteroid therapy in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Smoking status has been shown to affect corticosteroid response. Whether the association between high blood eosinophils and corticosteroid treatment failure is modified by smoking has not been fully investigated so far. OBJECTIVES This study aimed to assess whether the association between high blood eosinophils and corticosteroid treatment failure is modified by smoking. METHODS We included 3402 inpatients with AECOPD treated with corticosteroids at Beijing Chao-Yang Hospital from July 2013 to June 2021. Blood eosinophil counts were measured within 24 hours of admission. An eosinophil percentage ≥2% was considered as high eosinophilic. Smokers in this study were defined as current or former smokers. Treatment failure was defined as a worsening of AECOPD that led to adverse clinical outcomes or required further treatment or an extended hospital stay or hospitalisation following the exacerbation. Multivariate-adjusted logistic models were used to estimate the OR and 95% CI associated with treatment failure. RESULTS There were 958 (28.2%) treatment failure events occurring. Patients with high eosinophils had a lower risk of treatment failure (OR 0.74, 95% CI 0.63 to 0.87) than patients with low eosinophils. Compared with never smoking and low eosinophilic group, the ORs for treatment failure were 0.70 (95% CI 0.52 to 0.96) for never smoking and high eosinophilic group, 0.82 (95% CI 0.64 to 1.05) for smoking and low eosinophilic group and 0.62 (95% CI 0.47 to 0.81) for smoking and high eosinophilic group. Furthermore, there was no significant interaction between eosinophils and smoking status in relation to treatment failure (p for interaction=0.73). Similar results were obtained from multiple secondary outcomes and subgroup analyses. CONCLUSION Elevated blood eosinophils are associated with a lower rate of corticosteroid treatment failure, regardless of smoking status. Smoking does not modify the association between blood eosinophil level and corticosteroid treatment failure among inpatients with AECOPD.
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Affiliation(s)
- Jiachen Li
- Department of Clinical Epidemiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yingting Zuo
- Department of Clinical Epidemiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Lin Feng
- Department of Clinical Epidemiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yutong Samuel Cai
- Centre for Environmental Health and Sustainability, Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Jian Su
- School of Economics, Peking University, Beijing, China
| | - Zhaohui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Lirong Liang
- Department of Clinical Epidemiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Ki YJ, Han K, Kim HS, Han JK. Smoking and cardiovascular outcomes after percutaneous coronary intervention: a Korean study. Eur Heart J 2023; 44:4461-4472. [PMID: 37757448 DOI: 10.1093/eurheartj/ehad616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 08/02/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND AND AIMS The authors investigated the impact of smoking and its cessation after percutaneous coronary intervention (PCI) on cardiovascular outcomes. METHODS Using a nationwide database from the Korean National Health Insurance System, 74 471 patients undergoing PCI between 2009 and 2016 were classified as non-, ex-, or current smokers, depending on smoking status at the first health check-up within 1 year after PCI. The primary outcome was major adverse cardiovascular and cerebrovascular event (MACCE), a composite of all-cause death, myocardial infarction, coronary revascularization, and stroke. RESULTS During 4.0 years of follow-up, current smokers had a 19.8% higher rate of MACCE than non-smokers [adjusted hazard ratio (aHR) 1.198; 95% confidence interval (CI) 1.137-1.263], and ex-smokers tended to have a comparable rate with that of non-smokers (aHR 1.036; 95% CI .992-1.081). For 31 887 patients with both pre- and post-PCI health check-up data, the effects of smoking cessation were analysed. Among quitters who stopped smoking after PCI, quitters with cumulative smoking exposure of <20 pack-years (PYs) tended to have a comparable rate of MACCE with that of persistent non-smokers. However, the rate in quitters with cumulative exposure of ≥20 PYs was comparable with that of persistent smokers [aHR (95% CI) for <10 PY, 1.182 (.971-1.438); 10-20 PYs 1.114 (.963-1.290); 20-30 PYs 1.206 (1.054-1.380); ≥ 30 PYs 1.227 (1.113-1.352); persistent smokers 1.223 (1.126-1.328), compared with persistent non-smokers, respectively, P for interaction <.001]. CONCLUSIONS Smoking is associated with a higher risk of adverse outcomes in patients undergoing PCI. Quitters after PCI with <20 PYs were associated with a risk comparable with that of non-smokers.
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Affiliation(s)
- You-Jeong Ki
- Cardiovascular Center, Uijeongbu Eulji Medical Center, Uijeongbu-si, Gyeonggi-do, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Hyo-Soo Kim
- Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Department of Internal Medicine, College of Medicine, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Jung-Kyu Han
- Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Department of Internal Medicine, College of Medicine, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
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Zhang L, Zhu Y, Meng X, Zhang Y, Ren Q, Huang D, Chen Z. Smoking, immunity, and cardiovascular prognosis: a study of plasma IgE concentration in patients with acute myocardial infarction. Front Cardiovasc Med 2023; 10:1174081. [PMID: 37731521 PMCID: PMC10508960 DOI: 10.3389/fcvm.2023.1174081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Background Immunoglobulin E (IgE) is implicated in the pathogenesis of acute myocardial infarction (AMI), and smokers often exhibit elevated plasma IgE levels. However, it remains uncertain whether the role of smoking in the development and prognosis of AMI is influenced by IgE levels. This study aimed to investigate the potential contribution of IgE in mediating the association between smoking and AMI. Methods We conducted a prospective study involving 348 consecutive patients with chest discomfort who underwent coronary angiography. Plasma cotinine, an alkaloid present in tobacco, and IgE levels were measured. The patients were followed up for mean 39-months to assess their long-term prognosis based on major adverse cardiac and cerebrovascular events (MACCE). Results Our findings indicate that patients with AMI had higher plasma levels of cotinine and IgE. Univariate analyses demonstrated a positive association between plasma cotinine (OR = 1.7, 95% CI: 1.27-2.26, P < 0.001) and IgE (OR = 2.8, 95% CI: 1.75-4.39, P < 0.001) with AMI. Receiver operating characteristics analyses showed that the combined use of cotinine and IgE (AUC: 0.677) had a larger predictive performance compared to cotinine alone (AUC: 0.639) or IgE alone (AUC: 0.657), although the improvement did not reach statistical significance. Multivariable logistic regression revealed a positive association between plasma cotinine and AMI (OR = 1.70, 95% CI: 1.04-2.78, P = 0.036). Furthermore, the inclusion of plasma IgE in the regression model led to a decrease in the OR and 95% CI of plasma cotinine (OR = 1.66, 95% CI: 1.01-2.73, P = 0.048). Process mediation analyses showed a significant indirect effect of plasma cotinine on AMI mediated through increased plasma IgE. Kaplan-Meier analysis during a mean 39-months follow-up revealed that higher plasma levels of IgE were associated with an increased risk of MACCE following AMI (P = 0.047). However, in the context of the COX regression analysis, no significant correlation was observed between IgE, cotinine and AMI. Conclusion Cotinine exhibits a positive association with AMI, wherein IgE plays a mediating role. Elevated plasma levels of IgE was positively associated with AMI and poor prognosis, which further confirms the adverse role of smoking on the incidence of AMI and prognosis. (Clinical trial registration: ChiCTR2100053000).
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Affiliation(s)
- Lili Zhang
- Department of Cardiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanrong Zhu
- Department of Cardiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Meng
- Department of Cardiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yifan Zhang
- Department of Cardiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Ren
- Department of Clinical Nutrition, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dong Huang
- Department of Cardiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhong Chen
- Department of Cardiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Cardiology, Shanghai Sixth People’s Hospital Fujian, Fujian, China
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Impact of Smoking Status on Mortality in STEMI Patients Undergoing Mechanical Reperfusion for STEMI: Insights from the ISACS-STEMI COVID-19 Registry. J Clin Med 2022; 11:jcm11226722. [PMID: 36431198 PMCID: PMC9698021 DOI: 10.3390/jcm11226722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
The so-called “smoking paradox”, conditioning lower mortality in smokers among STEMI patients, has seldom been addressed in the settings of modern primary PCI protocols. The ISACS−STEMI COVID-19 is a large-scale retrospective multicenter registry addressing in-hospital mortality, reperfusion, and 30-day mortality among primary PCI patients in the era of the COVID-19 pandemic. Among the 16,083 STEMI patients, 6819 (42.3%) patients were active smokers, 2099 (13.1%) previous smokers, and 7165 (44.6%) non-smokers. Despite the impaired preprocedural recanalization (p < 0.001), active smokers had a significantly better postprocedural TIMI flow compared with non-smokers (p < 0.001); this was confirmed after adjustment for all baseline and procedural confounders, and the propensity score. Active smokers had a significantly lower in-hospital (p < 0.001) and 30-day (p < 0.001) mortality compared with non-smokers and previous smokers; this was confirmed after adjustment for all baseline and procedural confounders, and the propensity score. In conclusion, in our population, active smoking was significantly associated with improved epicardial recanalization and lower in-hospital and 30-day mortality compared with previous and non-smoking history.
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Xu ZJ, Zhang YH, Chen SY, Wang DN, Wu ZL, Li W. Effects of smoking on the prognosis of anterior circulation acute ischemic stroke with intravenous thrombolysis. Clin Neurol Neurosurg 2022; 220:107365. [PMID: 35868203 DOI: 10.1016/j.clineuro.2022.107365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 06/09/2022] [Accepted: 07/11/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This is a single-center retrospective analysis of the clinical data of 516 patients with acute ischemic stroke who underwent intravenous thrombolysis. This study was conducted to compare the therapeutic efficacy of smokers and non-smokers. METHODS Univariate analysis was used to analyze and compare the clinical data of smokers and non-smokers. Multivariate analysis was used to assess risk factors affecting the 90-day modified Rankin Scale (mRS) score. RESULTS Among the 516 patients, 235 (45.5 %) were smokers. Univariate analysis showed that smokers have a better 90-day prognosis and a lower 90-day mRS score than non-smokers. Multivariate logistic regression analysis showed that smoking is not a protective factor affecting prognosis, while baseline National Institutes of Health Stroke Scale (NIHSS) score was an independent risk factor affecting the 90-day functional outcome. Subgroup analysis did not determine a relationship between the 90-day mRS score and the smoking intensity and duration. CONCLUSION Smoking was not associated with a good 90-day prognosis after intravenous thrombolysis (IVT) treatment. The good clinical outcome of smokers in univariate analysis was bound up with their baseline characteristics. Baseline NIHSS score was the independent risk factor that affected the 90-day outcome of AIS patients undergoing IVT.
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Affiliation(s)
- Zhi-Jia Xu
- Base of Postgraduate Cultivating, General Hospital of Northern Theater Command, Jinzhou Medical University, Shenyang, Liaoning, China; Department of Neurology, Baicheng 321 Hospital, Baicheng, Jilin, China
| | - Yi-He Zhang
- Department of Neurology, the First Hospital of Jilin University, Changchun, Jilin, China
| | - Shao-Yuan Chen
- Department of Neurology, Baicheng 321 Hospital, Baicheng, Jilin, China
| | - Dong-Ni Wang
- Base of Postgraduate Cultivating, General Hospital of Northern Theater Command, Jinzhou Medical University, Shenyang, Liaoning, China
| | - Ze-Lai Wu
- Base of Postgraduate Cultivating, General Hospital of Northern Theater Command, Jinzhou Medical University, Shenyang, Liaoning, China
| | - Wei Li
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, Liaoning, China.
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Limpijankit T, Chandavimol M, Srimahachota S, Siriyotha S, Thakkinstian A, Krittayaphong R, Sansanayudh N. No Paradoxical Effect of Smoking Status on Recurrent Cardiovascular Events in Patients Following Percutaneous Coronary Intervention: Thai PCI Registry. Front Cardiovasc Med 2022; 9:888593. [PMID: 35711351 PMCID: PMC9197099 DOI: 10.3389/fcvm.2022.888593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/11/2022] [Indexed: 11/22/2022] Open
Abstract
Background "Smoker's paradox" is a controversial phenomenon that describes an unexpectedly favorable short-term outcome of smokers post-percutaneous coronary intervention (PCI). This study aimed to evaluate the effect of smoking status on recurrent major adverse cardiovascular events (MACEs) in patients who recently underwent PCI and to determine whether it was paradoxical. Methods This study utilized data from the nationwide Thai PCI registry, enrolling patients during 2018-2019. Our study factor was smoking status, classified as current smokers, ex-smokers, and nonsmokers. The outcome of interest was the time to occurrence of a composite of MACEs (i.e., all-cause death, myocardial infarction (MI), stroke, and unplanned revascularization) evaluated at about 1-year post-PCI. A propensity score (PS) model using inverse probability weighting with regression adjustment was used to estimate the effect of smoking on the occurrence of MACE. Results Current smokers, ex-smokers, and non-smokers accounted for 23, 32, and 45% of the 22,741 subjects, respectively. Smokers were younger, more frequently male, and had fewer traditional atherosclerotic risk factors. Current smokers presented more frequently with ST-elevation MIs (STEMIs) and cardiogenic shock (54 and 14.6%, respectively) than non-smokers. MACE rates were 1.9, 1.2, and 1.6 per 100 patients per month in the current smokers, ex-smokers, and non-smokers, respectively. After applying a PS, patients with a history of current smoking and ex-smoking developed the onset of recurrent MACEs significantly sooner than non-smokers, with a median time of 4.4 vs. 4.9 vs. 13.5 months (p < 0.001), respectively. Conclusions "Smoker's paradox" was not observed in our patient population. Current smokers and ex-smokers were prone to develop an earlier onset of a post-PCI MACEs than nonsmokers and need a smoke cessation program for further prevention.
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Affiliation(s)
- Thosaphol Limpijankit
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Mann Chandavimol
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suphot Srimahachota
- Division of Cardiovascular Diseases, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Sukanya Siriyotha
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nakarin Sansanayudh
- Cardiology Unit, Department of Internal Medicine, Pharmongkutklao Hospital, Bangkok, Thailand
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Kızıltunç E, Şahin YB, Topal S, Düzenli MA, Karakaya E, Aygül N, Topsakal R, Özdemir K, Abacı A. Efeitos do Ato de Fumar na Mortalidade de Longo Prazo após Infarto do Miocárdio por Elevação de ST. Arq Bras Cardiol 2021; 118:24-32. [PMID: 35195205 PMCID: PMC8959056 DOI: 10.36660/abc.20201036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 01/27/2021] [Indexed: 11/18/2022] Open
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Yasnitsky LN, Dumler AA, Cherepanov FM, Yasnitsky VL, Uteva NA. Capabilities of neural network technologies for extracting new medical knowledge and enhancing precise decision making for patients. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2021. [DOI: 10.1080/23808993.2021.1993595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Leonid N. Yasnitsky
- Department of Applied Mathematics and Informatics, Perm State University, Perm, Russia
- Department of Information Technology in Business, Higher School of Economics, Perm, Russia
| | - Andrey A. Dumler
- Department of Propedeutics of Internal Diseases No. 1, Perm State Medical University, Perm, Russia
| | - Fedor M. Cherepanov
- Department of Applied Informatics, Perm State University for Humanities and Pedagogy, Perm, Russia
| | - Vitaly L. Yasnitsky
- Department of Computational Mathematics, Mechanics and Biomechanics, Perm National Research Polytechnic University, Perm, Russia
| | - Natalia A. Uteva
- Department of Propedeutics of Internal Diseases No. 1, Perm State Medical University, Perm, Russia
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Nicolau JC, Feitosa Filho GS, Petriz JL, Furtado RHDM, Précoma DB, Lemke W, Lopes RD, Timerman A, Marin Neto JA, Bezerra Neto L, Gomes BFDO, Santos ECL, Piegas LS, Soeiro ADM, Negri AJDA, Franci A, Markman Filho B, Baccaro BM, Montenegro CEL, Rochitte CE, Barbosa CJDG, Virgens CMBD, Stefanini E, Manenti ERF, Lima FG, Monteiro Júnior FDC, Correa Filho H, Pena HPM, Pinto IMF, Falcão JLDAA, Sena JP, Peixoto JM, Souza JAD, Silva LSD, Maia LN, Ohe LN, Baracioli LM, Dallan LADO, Dallan LAP, Mattos LAPE, Bodanese LC, Ritt LEF, Canesin MF, Rivas MBDS, Franken M, Magalhães MJG, Oliveira Júnior MTD, Filgueiras Filho NM, Dutra OP, Coelho OR, Leães PE, Rossi PRF, Soares PR, Lemos Neto PA, Farsky PS, Cavalcanti RRC, Alves RJ, Kalil RAK, Esporcatte R, Marino RL, Giraldez RRCV, Meneghelo RS, Lima RDSL, Ramos RF, Falcão SNDRS, Dalçóquio TF, Lemke VDMG, Chalela WA, Mathias Júnior W. Brazilian Society of Cardiology Guidelines on Unstable Angina and Acute Myocardial Infarction without ST-Segment Elevation - 2021. Arq Bras Cardiol 2021; 117:181-264. [PMID: 34320090 PMCID: PMC8294740 DOI: 10.36660/abc.20210180] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- José Carlos Nicolau
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Gilson Soares Feitosa Filho
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brasil
- Centro Universitário de Tecnologia e Ciência (UniFTC), Salvador, BA - Brasil
| | - João Luiz Petriz
- Hospital Barra D'Or, Rede D'Or São Luiz, Rio de Janeiro, RJ - Brasil
| | | | | | - Walmor Lemke
- Clínica Cardiocare, Curitiba, PR - Brasil
- Hospital das Nações, Curitiba, PR - Brasil
| | | | - Ari Timerman
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | - José A Marin Neto
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Ribeirão Preto, SP - Brasil
| | | | - Bruno Ferraz de Oliveira Gomes
- Hospital Barra D'Or, Rede D'Or São Luiz, Rio de Janeiro, RJ - Brasil
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | | | | | - Carlos Eduardo Rochitte
- Hospital do Coração (HCor), São Paulo, SP - Brasil
- Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | - Edson Stefanini
- Escola Paulista de Medicina da Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
| | | | - Felipe Gallego Lima
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | - José Maria Peixoto
- Universidade José do Rosário Vellano (UNIFENAS), Belo Horizonte, MG - Brasil
| | - Juliana Ascenção de Souza
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Lilia Nigro Maia
- Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP - Brasil
| | | | - Luciano Moreira Baracioli
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Luís Alberto de Oliveira Dallan
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Luis Augusto Palma Dallan
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Luiz Carlos Bodanese
- Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS - Brasil
| | | | | | - Marcelo Bueno da Silva Rivas
- Rede D'Or São Luiz, Rio de Janeiro, RJ - Brasil
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Múcio Tavares de Oliveira Júnior
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Nivaldo Menezes Filgueiras Filho
- Universidade do Estado da Bahia (UNEB), Salvador, BA - Brasil
- Universidade Salvador (UNIFACS), Salvador, BA - Brasil
- Hospital EMEC, Salvador, BA - Brasil
| | - Oscar Pereira Dutra
- Instituto de Cardiologia - Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Otávio Rizzi Coelho
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), Campinas, SP - Brasil
| | | | | | - Paulo Rogério Soares
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | - Roberto Esporcatte
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | - Talia Falcão Dalçóquio
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - William Azem Chalela
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Wilson Mathias Júnior
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
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12
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Nah S, Choi S, Lee SU, Kim GW, Lee YH, Han S. Effects of smoking on delayed neuropsychiatric sequelae in acute carbon monoxide poisoning: A prospective observational study. Medicine (Baltimore) 2021; 100:e26032. [PMID: 34011113 PMCID: PMC8137110 DOI: 10.1097/md.0000000000026032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/03/2021] [Indexed: 01/05/2023] Open
Abstract
Smoking is a well-known risk factor for cardio-cerebrovascular disease. However, several studies have reported the "smoker's paradox" whereby smokers have a better prognosis for cardio-cerebrovascular diseases. Similar to cardio-cerebrovascular diseases, hypoxia is one of the major mechanisms of injury in carbon monoxide (CO) poisoning. This study investigated the association between smoking and delayed neuropsychiatric sequelae (DNS) in acute CO poisoning.This study involved patients with CO poisoning treated at a university hospital in Bucheon, Korea between September 2017 and March 2020. The exclusion criteria were age <18 years, discharge against medical advice, loss to follow-up, persistent neurological symptoms at discharge, transfer from another hospital 24 hours after exposure, and transfer from another hospital after hyperbaric oxygen therapy. Logistic regression analysis was performed to find factors associated with DNS.Two hundred sixty three patients visited the hospital due to CO poisoning and of these, 54 were excluded. DNS was evaluated up to 3 months after discharge, and until this time, DNS occurred in 35 (16.8%) patients. And the incidence rate of DNS was lower in smokers than non-smokers (15, 12% vs 20, 23.8%, P = .040). Multivariable logistic regression analysis revealed that CO exposure time (odds ratio [OR] 1.003; confidence interval [CI] 1.001-1.005; P = .003), the Glasgow coma scale (GCS) (OR 0.862; CI 0.778-0.956; P = .005), and pack-years (OR 0.947; CI 0.903-0.993; P = .023) were statistically significant for DNS development.These results indicate that more pack-years smoked were associated with reduced risk of the development of DNS in acute CO poisoning, and that CO exposure time and GCS is a predictive factor for DNS occurrence.
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Affiliation(s)
- Sangun Nah
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sungwoo Choi
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, Republic of Korea
| | - Gi Woon Kim
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Young Hwan Lee
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
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13
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Effect of Smoking on Outcomes of Primary PCI in Patients With STEMI. J Am Coll Cardiol 2020; 75:1743-1754. [PMID: 32299585 DOI: 10.1016/j.jacc.2020.02.045] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/23/2020] [Accepted: 02/13/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Smoking is a well-established risk factor for ST-segment elevation myocardial infarction (STEMI); however, once STEMI occurs, smoking has been associated with favorable short-term outcomes, an observation termed the "smoker's paradox." It has been postulated that smoking might exert protective effects that could reduce infarct size, a strong independent predictor of worse outcomes after STEMI. OBJECTIVES The purpose of this study was to determine the relationship among smoking, infarct size, microvascular obstruction (MVO), and adverse outcomes after STEMI. METHODS Individual patient-data were pooled from 10 randomized trials of patients with STEMI undergoing primary percutaneous coronary intervention. Infarct size was assessed at median 4 days by either cardiac magnetic resonance imaging or technetium-99m sestamibi single-photon emission computed tomography. Multivariable analysis was used to assess the relationship between smoking, infarct size, and the 1-year rates of death or heart failure (HF) hospitalization and reinfarction. RESULTS Among 2,564 patients with STEMI, 1,093 (42.6%) were recent smokers. Smokers were 10 years younger and had fewer comorbidities. Infarct size was similar in smokers and nonsmokers (adjusted difference: 0.0%; 95% confidence interval [CI]: -3.3% to 3.3%; p = 0.99). Nor was the extent of MVO different between smokers and nonsmokers. Smokers had lower crude 1-year rates of all-cause death (1.0% vs. 2.9%; p < 0.001) and death or HF hospitalization (3.3% vs. 5.1%; p = 0.009) with similar rates of reinfarction. After adjustment for age and other risk factors, smokers had a similar 1-year risk of death (adjusted hazard ratio [adjHR]: 0.92; 95% CI: 0.46 to 1.84) and higher risks of death or HF hospitalization (adjHR: 1.49; 95% CI: 1.09 to 2.02) as well as reinfarction (adjHR: 1.97; 95% CI: 1.17 to 3.33). CONCLUSIONS In the present large-scale individual patient-data pooled analysis, recent smoking was unrelated to infarct size or MVO, but was associated with a worse prognosis after primary PCI in STEMI. The smoker's paradox may be explained by the younger age and fewer cardiovascular risk factors in smokers compared with nonsmokers.
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14
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Takahashi K, Thuijs DJFM, Gao C, Ono M, Holmes DR, Mack MJ, Morice MC, Mohr FW, Curzen N, Davierwala PM, Milojevic M, Dawkins KD, Wykrzykowska JJ, de Winter RJ, McEvoy JW, Onuma Y, Head SJ, Kappetein AP, Serruys PW. Ten-year all-cause mortality according to smoking status in patients with severe coronary artery disease undergoing surgical or percutaneous revascularization. Eur J Prev Cardiol 2020; 29:312-320. [PMID: 33624046 DOI: 10.1093/eurjpc/zwaa089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/13/2020] [Accepted: 09/18/2020] [Indexed: 11/14/2022]
Abstract
AIMS To evaluate the impact of various smoking status on 10-year all-cause mortality and to examine a relative treatment benefit of coronary artery bypass grafting (CABG) vs. percutaneous coronary intervention (PCI) according to smoking habits. METHODS AND RESULTS The SYNTAX Extended Survival study evaluated vital status up to 10 years in 1800 patients with de novo three-vessel disease and/or left main coronary artery disease randomized to CABG or PCI in the SYNTAX trial. In the present analysis, patients were divided into three groups (current, former, or never smokers), and the primary endpoint of 10-year all-cause mortality was assessed according to smoking status. Smoking status was available in 1793 (99.6%) patients at the time of randomization, of whom 363 were current smokers, 798 were former smokers, and 632 were never smokers. The crude rates of 10-year all-cause mortality were 29.7% in current smokers, 25.3% in former smokers, and 25.9% in never smokers (Log-rank P = 0.343). After adjustment for imbalances in baseline characteristics, current smokers had a significantly higher risk of 10-year all-cause mortality than never smokers [adjusted hazard ratio (aHR): 2.29; 95% confidence interval (CI): 1.60-3.27; P < 0.001], whereas former smokers did not. PCI was associated with a higher risk of all-cause mortality than CABG among current smokers (HR: 1.60; 95% CI: 1.09-2.35; P = 0.017), but it failed to show a significant interaction between revascularization strategies and smoking status (Pinteraction = 0.910). CONCLUSION Current smokers had a higher adjusted risk of 10-year all-cause mortality, whereas former smokers did not. The treatment effect of CABG vs. PCI did not differ significantly according to smoking status. CLINICAL TRIAL REGISTRATION SYNTAX: ClinicalTrials.gov reference: NCT00114972; SYNTAX Extended Survival. ClinicalTrials.gov reference: NCT03417050.
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Affiliation(s)
- Kuniaki Takahashi
- Department of Cardiology, Amsterdam Universities Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniel J F M Thuijs
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Chao Gao
- Department of Cardiology, Radboud Medical Center, Nijmegen, The Netherlands
| | - Masafumi Ono
- Department of Cardiology, Amsterdam Universities Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - David R Holmes
- Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael J Mack
- Department of Cardiothoracic Surgery, Baylor Scott & White Health, Dallas, TX, USA
| | - Marie-Claude Morice
- Département of Cardiologie, Hôpital privé Jacques Cartier, Générale de Santé Massy, Paris, France
| | | | - Nick Curzen
- Department of Cardiology, Coronary Research Group, University Hospital Southampton NHS FT, Southampton, UK
| | - Piroze M Davierwala
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Milan Milojevic
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Keith D Dawkins
- Shockwave Medical Inc, 5403 Betsy Ross Dr Santa Clara, CA 95054, Santa Clara, CA, USA
| | - Joanna J Wykrzykowska
- Department of Cardiology, Amsterdam Universities Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Robbert J de Winter
- Department of Cardiology, Amsterdam Universities Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - John William McEvoy
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Stuart J Head
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Arie Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
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15
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Kufner A, Ebinger M, Luijckx GJ, Endres M, Siegerink B. Smoking Does Not Alter Treatment Effect of Intravenous Thrombolysis in Mild to Moderate Acute Ischemic Stroke-A Dutch String-of-Pearls Institute (PSI) Stroke Study. Front Neurol 2020; 11:786. [PMID: 32849233 PMCID: PMC7411739 DOI: 10.3389/fneur.2020.00786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/25/2020] [Indexed: 12/03/2022] Open
Abstract
Background: The smoking-thrombolysis paradox refers to a better outcome in smokers who suffer from acute ischemic stroke (AIS) following treatment with thrombolysis. However, studies on this subject have yielded contradictory results and an interaction analysis of exposure to smoking and thrombolysis in a large, multicenter database is lacking. Methods: Consecutive AIS patients admitted within 12 h of symptom onset between 2009 and 2014 from the prospective, multicenter stroke registry (Dutch String-of-Pearls Stroke Study) were included for this analysis. We performed a generalized linear model for functional outcome 3 months post-stroke depending on risk of the exposure variables (smoking yes/no, thrombolysis yes/no). The following confounders were adjusted for: age, smoking, hypertension, atrial fibrillation, diabetes mellitus, stroke severity, and stroke etiology. Results: Out of 468 patients, 30.6% (N = 143) were smokers and median baseline NIHSS was 3 (interquartile range 1–6). Smoking alone had a crude and adjusted relative risk (RR) of 0.99 (95% CI 0.89–1.10) and 0.96 (95% CI 0.86–1.01) for good outcome (modified Rankin Score ≤ 2), respectively. A combination of exposure variables (smoking and thrombolysis) did not change the results significantly [crude RR 0.87 (95% CI 0.74–1.03], adjusted RR 1.1 (95%CI 0.90–1.30)]. Smoking alone had an adjusted RR of 1.2 (95% CI 0.6–2.7) for recanalization following thrombolysis (N = 88). Conclusions: In patients with mild to moderate AIS admitted within 12 h of symptom onset, smoking did not modify treatment effect of thrombolysis.
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Affiliation(s)
- Anna Kufner
- Center for Stroke Research Berlin (CSB), Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,Klinik für Neurologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Ebinger
- Center for Stroke Research Berlin (CSB), Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Gert Jan Luijckx
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Matthias Endres
- Center for Stroke Research Berlin (CSB), Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,Klinik für Neurologie, Charité Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,Excellence Cluster NeuroCure, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Bob Siegerink
- Center for Stroke Research Berlin (CSB), Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
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16
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Shahim B, Redfors B, Chen S, Morice MC, Gersh BJ, Puskas JD, Kandzari DE, Merkely B, Horkay F, Crowley A, Serruys PW, Kappetein AP, Sabik JF, Ben-Yehuda O, Stone GW. Outcomes After Left Main Coronary Artery Revascularization by Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting According to Smoking Status. Am J Cardiol 2020; 127:16-24. [PMID: 32360038 DOI: 10.1016/j.amjcard.2020.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
Cigarette smoking is a well-known risk factor for coronary artery disease (CAD). However, the impact of smoking on outcomes after coronary revascularization, especially in patients with left main CAD (LMCAD) is less well understood. The EXCEL trial randomized 1,905 patients with LMCAD and visually assessed low or intermediate anatomical complexity (SYNTAX score ≤32) to PCI with everolimus-eluting stents or CABG. Patients were categorized according to smoking status (current, former, or never), and their outcomes at 5 years were compared by logistic regression with follow-up time included as a log-transformed offset variable. The primary endpoint was a composite of death, myocardial infarction, or stroke. Among 1893 patients with known smoking status at baseline, 416 (22%) were current smokers and 774 (41%) were former smokers. The crude rates of the primary endpoint were 19.5% for never smokers, 20.5% for former smokers (p = 0.61 vs never smokers), and 23.1% for smokers (p = 0.15 vs never smokers). Compared with never smokers, the adjusted risk of the primary endpoint was higher for current smokers (adjOR 1.82, 95% confidence interval [CI] 1.126 to 2.63; p = 0.001), but not for former smokers (adjOR 1.00, 95% CI 0.75 to 1.33, p = 0.10). The relative efficacy of PCI versus CABG for the 5-year primary endpoint was similar irrespective of smoking status (Pinteraction = 0.22). In conclusion, current smokers in the EXCEL trial had a higher adjusted 5-year risk of the primary composite endpoint of death, myocardial infarction, or stroke than never smokers, whereas former smokers were not at increased risk. Active smoking was a risk factor after LMCAD revascularization irrespective of revascularization method.
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17
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Abstract
Patients with stroke have a high risk of infection which may be predicted by age, procalcitonin, interleukin-6, C-reactive protein, National Institute of Health stroke scale (NHSS) score, diabetes, etc. These prediction methods can reduce unfavourable outcome by preventing the occurrence of infection.We aim to identify early predictors for urinary tract infection in patients after stroke.In 186 collected acute stroke patients, we divided them into urinary tract infection group, other infection type groups, and non-infected group. Data were recorded at admission. Independent risk factors and infection prediction model were determined using Logistic regression analyses. Likelihood ratio test was used to detect the prediction effect of the model. Receiver operating characteristic curve and the corresponding area under the curve were used to measure the predictive accuracy of indicators for urinary tract infection.Of the 186 subjects, there were 35 cases of urinary tract infection. Elevated interleukin-6, higher NIHSS, and decreased hemoglobin may be used to predict urinary tract infection. And the predictive model for urinary tract infection (including sex, NIHSS, interleukin-6, and hemoglobin) have the best predictive effect.This study is the first to discover that decreased hemoglobin at admission may predict urinary tract infection. The prediction model shows the best accuracy.
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Affiliation(s)
- Ya-ming Li
- Department of Neurology, Jiading District Central Hospital affiliated to Shanghai University of Medicine & Health Sciences
| | - Jian-hua Xu
- Department of Neurology, Jiading District Central Hospital affiliated to Shanghai University of Medicine & Health Sciences
| | - Yan-xin Zhao
- Department of Neurology, Tenth People's Hospital affiliated to Tongji University, Shanghai, China
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18
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Bazan R, Luvizutto GJ, Braga GP, Bazan SGZ, Hueb JC, de Freitas CCM, Hamamoto Filho PT, Módolo GP, Trindade AP, Sobreira ML, Nunes HRDC, Leite JP, Pontes-Neto OM. Relationship of spontaneous microembolic signals to risk stratification, recurrence, severity, and mortality of ischemic stroke: a prospective study. Ultrasound J 2020; 12:6. [PMID: 32048064 PMCID: PMC7013020 DOI: 10.1186/s13089-020-0156-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/26/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction The presence of microembolic signals (MES) during the acute phase of stroke is poorly understood, and its role and clinical application in relation to risk stratification and prognosis in patients remain uncertain. We assessed the prevalence of spontaneous MES in acute stroke and their relationship with risk stratification, stroke recurrence, morbidity, and mortality. Patients and methods This was a prospective cohort study conducted in the Stroke Unit. The MES presence was evaluated by transcranial Doppler (TCD) in patients with ischemic stroke within 48 h. The outcomes (risk stratification, morbidity, mortality, and recurrence of a stroke) were followed up for 6 months. The relationship between risk stratification and MES was obtained by odds ratios and that between MES and stroke recurrence, morbidity, and mortality using multiple logistic regression; considering statistical significance at P < 0.05. Results Of the 111 patients studied, 70 were men (63.1%) and 90 were white (81.1%), with a median age of 68 years. The MES frequency was 7%. There was a significant relationship between MES and symptomatic carotid disease (OR = 22.7; 95% CI 4.1–125.7; P < 0.001), a shorter time to monitoring (OR = 12.4; 95% CI 1.4–105.4; P = 0.02), and stroke recurrence (OR = 16.83; 95% CI 2.01–141; P = .009). Discussion It was observed that the stroke recurrence adjusted for prior stroke was higher and earlier among patients with MES detection. In conclusion, MES demonstrated a significant correlation with symptomatic carotid disease and a shorter DELAY until monitoring, and could be a predictor for the early recurrence of stroke in the long term.
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Affiliation(s)
- Rodrigo Bazan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, UNESP-Univ Estadual Paulista, Campus de Botucatu, Distrito de Rubião Jr, s/n, Botucatu, Brazil
| | - Gustavo José Luvizutto
- Department of Applied Physical Therapy, Institute of Health Sciences, UFTM-Univ Federal do Triângulo Mineiro, Uberaba, Brazil
| | - Gabriel Pereira Braga
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, UNESP-Univ Estadual Paulista, Campus de Botucatu, Distrito de Rubião Jr, s/n, Botucatu, Brazil
| | | | - João Carlos Hueb
- Department of Internal Medicine, Botucatu Medical School, UNESP-Univ Estadual Paulista, Botucatu, Brazil
| | - Carlos Clayton Macedo de Freitas
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, UNESP-Univ Estadual Paulista, Campus de Botucatu, Distrito de Rubião Jr, s/n, Botucatu, Brazil
| | - Pedro Tadao Hamamoto Filho
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, UNESP-Univ Estadual Paulista, Campus de Botucatu, Distrito de Rubião Jr, s/n, Botucatu, Brazil.
| | - Gabriel Pinheiro Módolo
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, UNESP-Univ Estadual Paulista, Campus de Botucatu, Distrito de Rubião Jr, s/n, Botucatu, Brazil
| | - André Petean Trindade
- Department of Tropical Diseases and Imaging Diagnosis, Botucatu Medical School, UNESP-Univ Estadual Paulista, Botucatu, Brazil
| | - Marcone Lima Sobreira
- Department of Surgery and Orthopedics, Botucatu Medical School, UNESP-Univ Estadual Paulista, Botucatu, Brazil
| | - Hélio Rubens de Carvalho Nunes
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, UNESP-Univ Estadual Paulista, Campus de Botucatu, Distrito de Rubião Jr, s/n, Botucatu, Brazil
| | - João Pereira Leite
- Department of Neuroscience and Behavior, Ribeirão Preto School of Medicine, USP-Univ São Paulo, Ribeirão Preto, Brazil
| | - Octávio Marques Pontes-Neto
- Department of Neuroscience and Behavior, Ribeirão Preto School of Medicine, USP-Univ São Paulo, Ribeirão Preto, Brazil
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Parasuraman S, Zaman AG, Egred M, Bagnall A, Broadhurst PA, Ahmed J, Edwards R, Das R, Garg D, Purcell I, Noman A. Smoking status and mortality outcomes following percutaneous coronary intervention. Eur J Prev Cardiol 2020; 28:1222-1228. [PMID: 33611373 DOI: 10.1177/2047487320902325] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/05/2020] [Indexed: 11/16/2022]
Abstract
Abstract
Objective
The aim of this study was to assess the impact of smoking on short (30-day) and intermediate (30-day to 6-month) mortality following percutaneous coronary intervention (PCI).
Background
The effect of smoking on mortality post-PCI is lacking in the modern PCI era.
Methods
This was a retrospective analysis of prospectively collected data comparing short- and intermediate-term mortality amongst smokers, ex-smokers and non-smokers.
Results
The study cohort consisted of 12,656 patients: never-smokers (n = 4288), ex-smokers (n = 4806) and current smokers (n = 3562). The mean age (±standard deviation) was 57 (±11) years in current smokers compared with 67 (±11) in ex-smokers and 67 (±12) in never-smokers; p < 0.0001. PCI was performed for acute coronary syndrome (ACS) in 84.1% of current smokers, 57% of ex-smokers and 62.9% in never-smokers; p < 0.0001. In a logistic regression model, the adjusted odds ratios (95% confidence intervals (CIs)) for 30-day mortality were 1.60 (1.10–2.32) in current smokers and 0.98 (0.70–1.38) in ex-smokers compared with never-smokers. In the Cox proportional hazard model, the adjusted hazard ratios (95% CI) for mortality between 30 days and 6 months were 1.03 (0.65–1.65) in current smokers and 1.19 (0.84–1.67) in ex-smokers compared with never-smokers.
Conclusion
This large observational study of non-selected patients demonstrates that ex-smokers and never-smokers are of similar age at first presentation to PCI, and there is no short- or intermediate-term mortality difference between them following PCI. Current smokers undergo PCI at a younger age, more often for ACS, and have higher short-term mortality. These findings underscore the public message on the benefits of smoking cessation and the harmful effects of smoking.
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Affiliation(s)
| | | | | | | | | | | | | | - Raj Das
- Freeman Hospital, Newcastle upon Tyne, UK
| | - Deepak Garg
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
| | | | - Awsan Noman
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
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20
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Yadav M, Mintz GS, Généreux P, Liu M, McAndrew T, Redfors B, Madhavan MV, Leon MB, Stone GW. The Smoker's Paradox Revisited: A Patient-Level Pooled Analysis of 18 Randomized Controlled Trials. JACC Cardiovasc Interv 2019; 12:1941-1950. [PMID: 31521646 DOI: 10.1016/j.jcin.2019.06.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/16/2019] [Accepted: 06/11/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study examined the smoker's paradox using patient-level data from 18 prospective, randomized trials of patients undergoing percutaneous coronary intervention (PCI) with stent implantation. BACKGROUND Studies on the effects of smoking and outcomes among patients undergoing PCI have reported conflicting results. METHODS Data from the RAVEL, E-SIRIUS, SIRIUS, C-SIRIUS, TAXUS IV and V, ENDEAVOR II to IV, SPIRIT II to IV, HORIZONS-AMI, COMPARE I and II, PLATINUM, and TWENTE I and II randomized trials were pooled. Patients were stratified by smoking status at time of enrollment. The 1- and 5-year ischemic outcomes were compared. RESULTS Among 24,354 patients with available data on smoking status, 6,722 (27.6%) were current smokers. Smokers were younger and less likely to have diabetes mellitus; hypertension; hyperlipidemia; or prior myocardial infarction (MI), PCI, or coronary artery bypass grafting. Angiographically, smokers had longer lesions, more complex lesions, and more occlusions, but were less likely to have moderate or severe calcification or tortuosity. At 5 years, smokers had significantly higher rates of MI (7.8% vs. 5.6%; p < 0.0001) and definite or probable stent thrombosis (3.5% vs. 1.8%; p < 0.0001); however, there were no differences in the rates of death, cardiac death, target lesion revascularization, or composite endpoints (cardiac death, target vessel MI, or ischemic target lesion revascularization). After multivariable adjustment for potential confounders, smoking was a strong independent predictor of death (hazard ratio [HR]: 1.86; 95% confidence interval [CI]: 1.63 to 2.12; p < 0.0001), cardiac death (HR: 1.68; 95% CI: 1.38 to 2.05; p < 0.0001), MI (HR: 1.38; 95% CI: 1.20 to 1.58; p < 0.0001), stent thrombosis (HR: 1.60; 95% CI: 1.28 to 1.99; p < 0.0001), and target lesion failure (HR: 1.17; 95% CI: 1.05 to 1.30; p = 0.005). CONCLUSIONS The present large, patient-level, pooled analysis with 5-year follow-up clearly demonstrates smoking to be an important predictor of adverse outcomes after PCI.
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Affiliation(s)
- Mayank Yadav
- Department of Medicine, Division of Cardiology, Bronx Lebanon Hospital Center, New York, New York
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Philippe Généreux
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey; Hôpital du Sacré-Coeur de Montréal, Montréal, Canada
| | - Mengdan Liu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Thomas McAndrew
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Mahesh V Madhavan
- Department of Medicine, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Martin B Leon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Department of Medicine, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Department of Medicine, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York.
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21
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Toluey M, Ghaffari S, Tajlil A, Nasiri B, Rostami A. The impact of cigarette smoking on infarct location and in-hospital outcome following acute ST-elevation myocardial infarction. J Cardiovasc Thorac Res 2019; 11:209-215. [PMID: 31579461 PMCID: PMC6759623 DOI: 10.15171/jcvtr.2019.35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 07/19/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction: Smoking, which is a major modifiable risk factor for coronary artery diseases, affects cardiovascular system with different mechanisms. We designed this study to investigate the association of smoking with location of ST-segment elevation myocardial infarction (STEMI), and short-term outcomes during hospitalization. Methods: In 1017 consecutive patients with anterior/inferior STEMI, comprehensive demographic, biochemical data, as well as clinical complications and mortality rate, were recorded. Patients were allocated into two groups based on smoking status and compared regarding the location of myocardial infarction, the emergence of clinical complications and in-hospital mortality in univariate and multivariate logistic regression analysis. Results: Among 1017 patients, 300 patients (29.5%) were smoker and 717 patients (70.5 %) were non-smoker. Smokers were significantly younger and had lower prevalence of diabetes, hyperlipidemia and hypertension. Inferior myocardial infarction was considerably more common in smokers than in non-smokers (45.7% vs. 36%, P = 0.001). Heart failure was developed more commonly in non-smokers (33.9% vs. 20%, P = 0.001). In-hospital mortality was significantly lower in smokers (6.7% vs. 17.3%, P = 0.001). After adjustment for confounding variables, smoking was independently associated with inferior myocardial infarction and lower heart failure [odds ratio: 1.44 (1.06-1.96), P = 0.01 and odds ratio: 0.61 (0.40-0.92), P = 0.02, respectively]. However, in-hospital mortality was not associated with smoking after adjustment for other factors [odds ratio: 0.69 (0.36-1.31), P = 0.2]. Conclusion: Smoking is independently associated with inferior myocardial infarction. Although smokers had lower incidence of heart failure, in-hospital mortality was not different after adjustment for other factors.
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Affiliation(s)
| | | | | | - Babak Nasiri
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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22
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Acioly MA, Shaikh KA, White IK, Ziemba-Davis M, Bohnstedt BN, Cohen-Gadol A. Predictors of Outcomes and Complications After Microsurgical and Endovascular Treatment of 1300 Intracranial Aneurysms. World Neurosurg 2019; 122:e516-e529. [PMID: 31108070 DOI: 10.1016/j.wneu.2018.10.094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/13/2018] [Accepted: 10/16/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND We performed a rigorous statistical analysis of the complications and outcomes of patients with ruptured or unruptured intracranial aneurysms. Our emphasis was on the potential predictive factors when both surgical and endovascular management are offered by a team with balanced microsurgical and endovascular expertise. METHODS From January 2005 to December 2011, 1297 consecutive patients presenting with ruptured (n=829) or unruptured (n=468) aneurysms were prospectively enrolled in our vascular database. The treatment modality was determined by consensus of the endovascular and microsurgical teams. The patients' medical and neurological conditions and aneurysm characteristics were compared against the postintervention complication rates and outcomes using multivariate analyses. RESULTS The patients mostly underwent clipping for ruptured (63.7%) or unruptured (56.6%) aneurysms. For ruptured aneurysms, higher Hunt and Hess and Fisher grades on admission were key predictors of increased neurological (P < 0.001 and P < 0.001, respectively) and medical (P < 0.001 and P=0.041, respectively) complication rates. No significant differences in the outcomes were observed between the coiling or clipping groups during the follow-up period. For the unruptured group, a family history of intracranial aneurysms was the most relevant predictor for reducing neurological complication rates and increasing survival at 6 months. Hypertension was, however, the strongest factor associated with complications negatively affecting the outcomes. CONCLUSIONS For the ruptured and unruptured groups both, the outcomes were generally good, although neurological and medical complications were reasonably more frequent for the ruptured aneurysms. Coiling provided a sustained benefit in lowering the complication rates only in the short term for the unruptured aneurysms. Smoking was associated, paradoxically, with improved outcomes.
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Affiliation(s)
- Marcus André Acioly
- Division of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Division of Neurosurgery, Fluminense Federal University, Niterói-Rio de Janeiro, Brazil
| | - Kashif A Shaikh
- Department of Neurological Surgery, Indiana University School of Medicine and Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA
| | - Ian K White
- Department of Neurological Surgery, Indiana University School of Medicine and Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA
| | - Mary Ziemba-Davis
- Department of Neurological Surgery, Indiana University School of Medicine and Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA
| | - Bradley N Bohnstedt
- Department of Neurosurgery, Oklahoma University, Oklahoma City, Oklahoma, USA
| | - Aaron Cohen-Gadol
- Department of Neurological Surgery, Indiana University School of Medicine and Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA.
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Abawi M, Gils L, Agostoni P, Mieghem NM, Kooistra NHM, Dongen CS, Jaarsveld RC, Jaegere PPT, Doevendans PAFM, Stella PR. Impact of baseline cigarette smoking status on clinical outcome after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2019; 94:795-805. [DOI: 10.1002/ccd.28175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/05/2019] [Accepted: 02/18/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Masieh Abawi
- Department of CardiologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Lennart Gils
- Department of Interventional CardiologyErasmus Medical Center Rotterdam The Netherlands
| | - Pierfrancesco Agostoni
- Department of CardiologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
- Department of CardiologyHartcentrum, ZNA Antwerp Belgiccdum
| | - Nicolas M. Mieghem
- Department of Interventional CardiologyErasmus Medical Center Rotterdam The Netherlands
| | - Nynke H. M. Kooistra
- Department of CardiologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Charlotte S. Dongen
- Department of CardiologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Romy C. Jaarsveld
- Department of CardiologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Peter P. T. Jaegere
- Department of Interventional CardiologyErasmus Medical Center Rotterdam The Netherlands
| | - Pieter A. F. M. Doevendans
- Department of CardiologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
- Netherlands Heart Institute Utrecht The Netherlands
| | - Pieter R. Stella
- Department of CardiologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
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Impact of smoking on cardiac magnetic resonance infarct characteristics and clinical outcome in patients with non-ST-elevation myocardial infarction. Int J Cardiovasc Imaging 2019; 35:1079-1087. [PMID: 30771036 DOI: 10.1007/s10554-019-01556-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/07/2019] [Indexed: 01/29/2023]
Abstract
Data derived from several studies suggest a better survival in smokers with acute myocardial infarction, a phenomenon referred to as the 'smoker's paradox'. We aimed to investigate the association of smoking with cardiac magnetic resonance (CMR) imaging determined infarct severity and major adverse cardiac events (MACE) defined as the occurrence of death, reinfarction, and congestive heart failure at 12 months in patients with non-ST-elevation myocardial infarction (NSTEMI) reperfused by early percutaneous coronary intervention (PCI). In this multicenter, registry study 311 NSTEMI patients underwent CMR imaging 3 (interquartile range [IQR] 2-4) days after PCI. Myocardial salvage index (MSI), infarct size (IS), and microvascular obstruction (MVO) as well as MACE rate were compared according to admission smoking status. Approximately one-third of patients were current smokers (n = 122, 39%). Smokers were significantly younger and less likely to have hypertension as compared to non-smokers (all p < 0.05). The extent of MSI (63.2, IQR 28.9-85.4 vs. 65.6, IQR 42.2-82.9, p = 0.30), and IS (7.2, IQR 2.3-15.7%LV vs. 7.0, IQR 2.2-12.4%LV, p = 0.27) did not differ significantly between smokers and non-smokers. Despite similar prevalence of MVO, MVO (%LV) was higher in smokers compared to non-smokers (2.0, IQR 0.9-4.7%LV vs. 1.2, IQR 0.7-2.2%LV, p = 0.03). MACE rates at 12 months were comparable in smokers and non-smokers (5.7% vs. 7.4%, p = 0.65). In NSTEMI patients, smoking is neither associated with increased myocardial salvage nor less severe myocardial damage. Clinical outcome at 12 months was similar in smokers and non-smokers.Trial registration NCT03516578.
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25
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Tobacco smoking protective effect via remote ischemic preconditioning on myocardial damage after elective percutaneous coronary intervention: Subanalysis of a randomized controlled trial. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VASCULATURE 2019; 22:55-60. [PMID: 30603663 PMCID: PMC6307096 DOI: 10.1016/j.ijcha.2018.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/06/2018] [Accepted: 12/16/2018] [Indexed: 11/24/2022]
Abstract
Background Remote ischemic preconditioning (RIPC) is promising for preventing periprocedural myocardial damage (pMD) in patients undergoing percutaneous coronary intervention (PCI). However, the impact of RIPC on pMD on smokers is not well elucidated. The aim of this study was to investigate an association between tobacco smoking and RIPC on pMD in patients planning to undergo PCI. Methods This study used data from a multicenter randomized controlled trial involving patients with stable angina who planned to undergo elective PCI. We analyzed data for 262 patients in the control (n = 133) and upper-limb RIPC (n = 129) groups, including 166 current or former smokers. The major outcome was the pMD incidence following PCI, with pMD defined as an elevated level of highly sensitive cardiac troponin T or a creatine kinase myocardial band 12 or 24 h after PCI. Results The incidence of pMD was significantly lower in the upper-limb RIPC group than in the control group (28/83 patients [33.8%] vs. 43/83 patients [51.8%], respectively; p = 0.018). In a multiple logistic regression model, tobacco smoking was an independent predictor of interacting with and enhancing the effect of RIPC on reducing the incidence of pMD after PCI (regression coefficient, −0.4 [95% confidence interval, −0.74 to −0.082]; p = 0.015). Conclusions Tobacco smoking may have a beneficial effect on RIPC against pMD after PCI.
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The smoker's paradox in acute coronary syndrome: Is it real? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Coutinho Cruz M, Ilhão Moreira R, Abreu A, Timóteo AT, Sá Carvalho R, Ferreira L, Cruz Ferreira R. The smoker's paradox in acute coronary syndrome: Is it real? Rev Port Cardiol 2018; 37:847-855. [DOI: 10.1016/j.repc.2017.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/25/2017] [Accepted: 12/02/2017] [Indexed: 10/28/2022] Open
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Connelly KA, Roifman I. STEMI, the Smoker's Paradox, and Cardiac Magnetic Resonance Imaging: It's All a Case of Smoke and Mirrors. JACC Cardiovasc Imaging 2018; 12:1004-1006. [PMID: 30031703 DOI: 10.1016/j.jcmg.2018.04.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 04/25/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Kim A Connelly
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, University of Toronto, Ontario, Canada.
| | - Idan Roifman
- Imaging Research Centre for Cardiovascular Interventions, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Gupta A, Verma SK, Sharma R, Parakh N, Ramakrishnan S, Roy A, Singh S, Sharma G, Karthikeyan G, Naik N, Yadav R, Mishra S, Seth S, Narang R, Goswami KC, Bhargava B, Bahl VK. Clinical and angiographic profiles and six months outcomes of smokers with acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary angioplasty. Indian Heart J 2018; 70:680-684. [PMID: 30392506 PMCID: PMC6205248 DOI: 10.1016/j.ihj.2018.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 01/15/2018] [Accepted: 02/28/2018] [Indexed: 12/05/2022] Open
Abstract
Background Outcomes of primary percutaneous coronary intervention (PCI) for acute STEMI (ST-segment elevation myocardial infarction) in smokers are expected to be better than non-smokers as for patients of acute STEMI with or without fibrinolytic therapy. Objectives This comparative study was designed to evaluate the outcomes of primary PCI in patients with acute STEMI in smokers and non-smokers. Clinical and angiographic profile of the two groups was also compared. Methods Over duration of two year, a total of 150 consecutive patients of acute STEMI eligible for primary PCI were enrolled and constituted the two groups [Smokers (n = 90), Non-smokers (n = 60)] of the study population. There was no difference in procedure in two groups. Results In the present study of acute STEMI, current smokers were about a decade younger than non-smokers (p value = 0.0002), majority were male (98.9% vs 56.6%) were male with a higher prevalence of hypertension and diabetes mellitus (61.67% vs 32.28% and 46.67% vs 14.44%, p = 0.001) respectively. Smokers tended to have higher thrombus burden (p = 0.06) but less multi vessel disease (p = 0.028). Thirty day and six month mortality was non-significantly higher in smokers 4.66% vs 1.33% (p = 0.261) and 5.33% vs 2.66% (p = NS) respectively. Rate of quitting smoking among smokers was 80.90% at 6 months. Conclusion The study documents that smokers with acute STEMI have similar outcomes as compared to non smokers with higher thrombus burden and lesser non culprit artery involvement. Smokers present at much younger age emphasizing the role of smoking cessation for prevention of myocardial infarction.
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Affiliation(s)
- A Gupta
- Senior Resident, Department of cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - S K Verma
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - R Sharma
- Senior Resident, Department of cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - N Parakh
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - S Ramakrishnan
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - A Roy
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - S Singh
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - G Sharma
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - G Karthikeyan
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - N Naik
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - R Yadav
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - S Mishra
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - S Seth
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - R Narang
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - K C Goswami
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - B Bhargava
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - V K Bahl
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Karamasis GV, Russhard P, Al Janabi F, Parker M, Davies JR, Keeble TR, Clesham GJ. Peri-procedural ST segment resolution during Primary Percutaneous Coronary Intervention (PPCI) for acute myocardial infarction: predictors and clinical consequences. J Electrocardiol 2017; 51:224-229. [PMID: 29108788 DOI: 10.1016/j.jelectrocard.2017.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE ECG ST segment resolution (STR) has been used to assess myocardial perfusion in STEMI patients undergoing PPCI. However, in most of the studies ECGs recorded at different time points after the actual procedure have been used, limiting the options of therapeutic interventions while the patient is still in the catheterisation laboratory. The aim of this study was to investigate the presence and clinical consequences of intra-procedural STR during PPCI. METHODS We analysed 12 lead ECGs recorded at the onset and the end of the PPCI procedure, measuring STR in the lead with maximum ST elevation on the initial recording. STR was defined as good when > 50% compared to baseline. RESULTS Pre and immediately post PPCI ECGs were recorded in 467 STEMI cases whilst the patient was on the catheter lab table. Mean patient age was 63 (+/- 12) years old and 75% were men. Mean duration of symptoms to admission was 3.8 (+/- 3.4) hours and 51% of infarcts were anterior. Good ST resolution at the end of the procedure was seen in 46.5% of patients and was observed more commonly in inferior compared to anterior infarcts (60.1% vs. 32.6%, p<0.001), and in current smokers (53.2% vs. 42.4%, p=0.031). In patients presenting with symptoms for < 4 hours, good STR was more common (74% vs. 66%, p=0.019). Thrombus aspiration was used more frequently in patients who had good STR (88.5% vs 79.8% p=0.011). Patients with good ST resolution had a shorter mean hospital length of stay (3.8 vs. 4.5 days, p=0.009) and a higher left ventricular ejection fraction (49.9% vs. 44.2%, p<0.001) measured by transthoracic echocardiography prior to discharge. CONCLUSION Good peri-procedural ST resolution was seen in less than half of STEMI patients undergoing PPCI. There were important clinical consequences of good ST resolution. Identification of suboptimal peri-procedural ST resolution could help identify patients who may benefit from new treatments aimed at protecting the microcirculation, whilst the patients are still in the angiography laboratory.
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Affiliation(s)
- Grigoris V Karamasis
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, Essex, UK; Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, Essex, UK
| | - Paul Russhard
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, Essex, UK
| | - Firas Al Janabi
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, Essex, UK; Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, Essex, UK
| | - Michael Parker
- Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, Essex, UK
| | - John R Davies
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, Essex, UK; Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, Essex, UK
| | - Thomas R Keeble
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, Essex, UK; Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, Essex, UK
| | - Gerald J Clesham
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, Essex, UK; Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, Essex, UK.
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Liu Y, Han T, Gao M, Wang J, Liu F, Zhou S, Chen Y. Clinical characteristics and prognosis of acute myocardial infarction in young smokers and non-smokers (≤ 45 years): a systematic review and meta-analysis. Oncotarget 2017; 8:81195-81203. [PMID: 29113379 PMCID: PMC5655274 DOI: 10.18632/oncotarget.21092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 09/04/2017] [Indexed: 11/25/2022] Open
Abstract
The effect of smoking on the prognosis of young patients with acute myocardial infarction (AMI) is inconclusive. We enrolled 2188 young AMI patients (≤ 45 years) from the cardiac center of the Chinese PLA General Hospital and Anzhen Hospital and analyzed their clinical characteristics and prognosis. We also searched the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials electronic databases for January 2001 to March 2017 and considered for inclusion in a meta-analysis those clinical trials that compared prognoses of young smokers and non-smokers with AMI. The proportion of males and alcohol users was higher in young AMI smokers than in non-smokers; the proportion of hypertension was slightly lower. There was no difference in medical treatment between smokers and non-smokers. No differences were evident between smokers and non-smokers regarding in-hospital cardiac events and major adverse cardiovascular events on follow-up, including incidence of stroke. For young AMI patients, smoking did not lead to poorer prognosisin comparison with not smoking. This “smoker's paradox” needs to be confirmed by more randomized controlled multicenter prospective clinical trials.
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Affiliation(s)
- Yuqi Liu
- Department of Cardiology, PLA General Hospital, Beijing 100853, China
| | - Tianwen Han
- Department of Cardiology, PLA General Hospital, Beijing 100853, China
| | - Ming Gao
- ICU of The First Phase Beijing Tsinghua Changgeng Hospital, Beijing 100044, China
| | - Jinwen Wang
- Department of Cardiology of Anzhen Hospital, Beijing 100029, China
| | - Fang Liu
- Department of Cardiology of Anzhen Hospital, Beijing 100029, China
| | - Shanshan Zhou
- Department of Cardiology, PLA General Hospital, Beijing 100853, China
| | - Yundai Chen
- Department of Cardiology, PLA General Hospital, Beijing 100853, China
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Hussein HM, Niemann N, Parker ED, Qureshi AI. Searching for the Smoker’s Paradox in Acute Stroke Patients Treated With Intravenous Thrombolysis. Nicotine Tob Res 2017; 19:871-876. [DOI: 10.1093/ntr/ntx020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 01/18/2017] [Indexed: 11/14/2022]
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"Smoker's paradox" in patients with cardiogenic shock complicating myocardial infarction - A substudy of the IABP-SHOCK II-trial and registry. Int J Cardiol 2016; 222:775-779. [PMID: 27521557 DOI: 10.1016/j.ijcard.2016.07.172] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 07/27/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Several studies in patients with acute myocardial infarction (AMI) without cardiogenic shock (CS) indicate a better survival in smokers, the so called "smoker's paradox". For CS, this relationship has not been investigated so far in the primary percutaneous coronary intervention (PCI) era. METHODS In a predefined substudy of the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial and its accompanying registry including patients with CS complicating AMI we investigated differences in outcome of smokers compared to non-smokers. All-cause-mortality at 1year was used as primary endpoint. RESULTS Of 772 patients with available smoking status 263 patients were smokers (34%). Smokers were more often male (79% vs. 65%; p<0.001), of younger age (61 [interquartile range IQR 52-70] vs. 73 [IQR 64-79] years; p<0.001), had less comorbidity including arterial hypertension (62% vs. 71%; p=0.007) and diabetes mellitus (26% vs. 38%; p<0.001) and had lower levels of serum creatinine (13% vs. 25%; p<0.001). There was no significant difference between the 2 groups regarding left ventricular ejection fraction, initial revascularization strategy or use of IABP. Smokers had lower rates of mortality at 12months in univariable analysis (43% vs. 59%; p<0.001) but not after adjustment for important confounders using Cox-regression analysis (hazard ratio 0.77, 95% confidence interval 0.59-1.03; p=0.08). CONCLUSION Smoking is not predictive of outcome in patients with CS complicating AMI. The observed survival benefit in univariable analysis seems to be explained by the younger age and lower risk profile of smokers.
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Kodaira M, Miyata H, Numasawa Y, Ueda I, Maekawa Y, Sueyoshi K, Ishikawa S, Ohki T, Negishi K, Fukuda K, Kohsaka S. Effect of Smoking Status on Clinical Outcome and Efficacy of Clopidogrel in Acute Coronary Syndrome. Circ J 2016; 80:1590-9. [PMID: 27245240 DOI: 10.1253/circj.cj-16-0032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The "smoker's paradox" is an otherwise unexplained phenomenon in which the mortality of smokers after acute myocardial infarction is reduced, contrary to expectations. It has been suggested that an association with antiplatelet agents exists, but the true mechanism remains largely unidentified. METHODS AND RESULTS The analysis included 6,195 consecutive patients who underwent percutaneous coronary intervention (PCI) for acute coronary syndrome, registered in the Japanese multicenter PCI registry. Smokers were significantly younger and had less comorbidity than non-smokers. Unadjusted in-hospital mortality rate, general complication rate, and bleeding complication rate were lower in smokers than in non-smokers. After adjustment, the trend persisted and smoking was not associated with overall mortality (odds ratio [OR], 0.90; 95% confidence interval [CI]: 0.61-1.34; P=0.62), and was associated with lower overall (P=0.032) and bleeding complication events (P=0.040). Clopidogrel effectively reduced the occurrence of in-hospital complications and major adverse cardiac events in smokers compared with non-smokers (OR, 0.55; 95% CI: 0.53-0.98 vs. OR, 1.20; 95% CI: 0.87-1.67; and OR, 0.37; 95% CI: 0.20-0.70 vs. OR, 1.48; 95% CI: 0.90-2.43, respectively). CONCLUSIONS The smoker's paradox was largely explained by confounding factors related to the lower risk profile of smokers, and they benefited from a positive modification of the efficacy of clopidogrel. (Circ J 2016; 80: 1590-1599).
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Gupta T, Kolte D, Khera S, Harikrishnan P, Mujib M, Aronow WS, Jain D, Ahmed A, Cooper HA, Frishman WH, Bhatt DL, Fonarow GC, Panza JA. Smoker's Paradox in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. J Am Heart Assoc 2016; 5:JAHA.116.003370. [PMID: 27107131 PMCID: PMC4843594 DOI: 10.1161/jaha.116.003370] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Prior studies have found that smokers undergoing thrombolytic therapy for ST-segment elevation myocardial infarction have lower in-hospital mortality than nonsmokers, a phenomenon called the "smoker's paradox." Evidence, however, has been conflicting regarding whether this paradoxical association persists in the era of primary percutaneous coronary intervention. METHODS AND RESULTS We used the 2003-2012 National Inpatient Sample databases to identify all patients aged ≥18 years who underwent primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Multivariable logistic regression was used to compare in-hospital mortality between smokers (current and former) and nonsmokers. Of the 985 174 patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, 438 954 (44.6%) were smokers. Smokers were younger, were more often men, and were less likely to have traditional vascular risk factors than nonsmokers. Smokers had lower observed in-hospital mortality compared with nonsmokers (2.0% versus 5.9%; unadjusted odds ratio 0.32, 95% CI 0.31-0.33, P<0.001). Although the association between smoking and lower in-hospital mortality was partly attenuated after baseline risk adjustment, a significant residual association remained (adjusted odds ratio 0.60, 95% CI 0.58-0.62, P<0.001). This association largely persisted in age-stratified analyses. Smoking status was also associated with shorter average length of stay (3.5 versus 4.5 days, P<0.001) and lower incidence of postprocedure hemorrhage (4.2% versus 6.1%; adjusted odds ratio 0.81, 95% CI 0.80-0.83, P<0.001) and in-hospital cardiac arrest (1.3% versus 2.1%; adjusted OR 0.78, 95% CI 0.76-0.81, P<0.001). CONCLUSIONS In this nationwide cohort of patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, we observed significantly lower risk-adjusted in-hospital mortality in smokers, suggesting that the smoker's paradox also applies to ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.
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Affiliation(s)
| | - Dhaval Kolte
- Brown University/Rhode Island Hospital, Providence, RI
| | | | | | | | | | | | - Ali Ahmed
- Veterans Affairs Medical Center, Washington, DC
| | | | | | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA
| | - Gregg C Fonarow
- David Geffen School of Medicine, University of California at Los Angeles, CA
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Reinstadler SJ, Eitel C, Fuernau G, de Waha S, Desch S, Mende M, Metzler B, Schuler G, Thiele H, Eitel I. Association of smoking with myocardial injury and clinical outcome in patients undergoing mechanical reperfusion for ST-elevation myocardial infarction. Eur Heart J Cardiovasc Imaging 2016; 18:39-45. [PMID: 26976354 DOI: 10.1093/ehjci/jew030] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 02/03/2016] [Indexed: 11/14/2022] Open
Abstract
AIMS There is evidence suggesting a positive effect of cigarette smoking on myocardial tissue reperfusion and clinical outcomes in patients with myocardial infarction ('smoker's paradox'). We aimed to evaluate the relationship of smoking with cardiac magnetic resonance (CMR)-determined myocardial salvage and damage as well as clinical outcomes in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS This multicentre study included 727 consecutive STEMI patients reperfused within 12 h after symptom onset. CMR imaging parameters [area at risk (AAR), infarct size (IS), myocardial salvage index (MSI), and microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH)] were compared according to admission smoking status. Major adverse cardiac event (MACE) rates at 12 months after infarction were compared between groups. Three hundred and thirty-nine (46.6%) patients were current smokers. There was no difference in the extent of AAR [35 (24-47) vs. 37 (27-49) % of left ventricular volume (LV), P = 0.10], IS [16 (8-25) vs. 17 (10-26) %LV, P = 0.21], MSI [53 (29-70) vs. 52 (34-71), P = 0.47], MVO [0 (0-1.7) vs. 0 (0-1.6) %LV, P = 0.91], or in the frequency of IMH (42 vs. 39%, P = 0.58) between smokers and non-smokers. Smokers had lower MACE (3.8 vs. 8.2%, P = 0.01) rates. However, adjustment for differences in baseline risk factors attenuated the association of smoking with MACE markedly (hazard ratio = 0.71, 95% confidence interval 0.36-1.38, P = 0.31). CONCLUSION Smoking is not associated with PPCI efficacy (myocardial salvage) or irreversible myocardial damage in patients with STEMI. The lower MACE rate of smokers was entirely explained by differences in baseline risk characteristics, thus challenging the existence of a smoker's paradox.
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Affiliation(s)
- Sebastian J Reinstadler
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology, and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck 6020, Austria
| | - Charlotte Eitel
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology, and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany
| | - Georg Fuernau
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology, and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany
| | - Suzanne de Waha
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology, and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany
| | - Steffen Desch
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology, and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany
| | - Meinhard Mende
- Clinical Trial Center Leipzig, University of Leipzig, Leipzig 04289, Germany
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck 6020, Austria
| | - Gerhard Schuler
- Department of Cardiology, Heart Center University Leipzig, Leipzig 04289, Germany
| | - Holger Thiele
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology, and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology, and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany
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Lee MH, Park JJ, Yoon CH, Cha MJ, Park SD, Oh IY, Suh JW, Cho YS, Youn TJ, Rha SW, Yu CW, Gwon HC, Jang Y, Kim HS, Chae IH, Choi DJ. Impact of smoking status on clinical outcomes after successful chronic total occlusion intervention: Korean national registry of CTO intervention. Catheter Cardiovasc Interv 2015; 87:1050-62. [DOI: 10.1002/ccd.26167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 07/22/2015] [Accepted: 07/27/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Min-Ho Lee
- Cardiovascular Center; Soonchunhyang University Hospital; Seoul Korea
| | - Jin Joo Park
- Cardiovascular Center; Seoul National University Bundang Hospital; Seongnam Korea
| | - Chang-Hwan Yoon
- Cardiovascular Center; Seoul National University Bundang Hospital; Seongnam Korea
| | - Myung-Jin Cha
- Cardiovascular Center; Seoul National University Hospital; Seoul Korea
| | - Sang-Don Park
- Cardiovascular Center; Seoul National University Bundang Hospital; Seongnam Korea
| | - Il-Young Oh
- Cardiovascular Center; Seoul National University Bundang Hospital; Seongnam Korea
| | - Jung-Won Suh
- Cardiovascular Center; Seoul National University Bundang Hospital; Seongnam Korea
| | - Young-Seok Cho
- Cardiovascular Center; Seoul National University Bundang Hospital; Seongnam Korea
| | - Tae-Jin Youn
- Cardiovascular Center; Seoul National University Bundang Hospital; Seongnam Korea
| | | | | | | | - Yangsoo Jang
- Yonsei University Severance Hospital; Seoul Korea
| | - Hyo-Soo Kim
- Cardiovascular Center; Seoul National University Hospital; Seoul Korea
| | - In-Ho Chae
- Cardiovascular Center; Seoul National University Bundang Hospital; Seongnam Korea
| | - Dong-Ju Choi
- Cardiovascular Center; Seoul National University Bundang Hospital; Seongnam Korea
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Kvistad CE, Oeygarden H, Logallo N, Thomassen L, Waje-Andreassen U, Naess H. Is smoking associated with favourable outcome in tPA-treated stroke patients? Acta Neurol Scand 2014; 130:299-304. [PMID: 24527872 DOI: 10.1111/ane.12225] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Smoking has been associated with improved outcome in thrombolysed patients with myocardial infarction and higher recanalization rates in stroke patients treated with tissue plasminogen activator (tPA). We hypothesized a positive association between smoking and favourable outcome in stroke patients treated with tPA and no such association in acute stroke patients not treated with tPA, suggesting a beneficial effect of smoking on thrombolysis with tPA. METHODS Stroke patients treated with tPA and stroke patients not treated with tPA, but presenting within 6 h after stroke onset, were included in two separate groups. Three groups were defined according to smoking habits: current smoking, previous smoking and no smoking. Functional outcome by modified Rankin Scale (mRS) was assessed after 1 week or at discharge, if discharged earlier. Favourable outcome was defined as mRS 0 or 1. RESULTS A total of 399 patients were treated with tPA (94 current smokers, 148 previous smokers and 157 non-smokers), whereas 424 patients were not treated with tPA (90 current smokers, 164 previous smokers and 170 non-smokers). Current smoking was independently associated with favourable outcome in patients treated with tPA when adjusted for confounders (OR 2.08, 95% CI 1.09-3.95, P = 0.025). There was no such association in acute stroke patients not treated with tPA (OR 1.26, 95% CI 0.67-2.36, P = 0.472). CONCLUSION Our study showed an association between current smoking and favourable short-term outcome in stroke patients treated with tPA, but not in acute stroke patients not treated with tPA. This may indicate a more effective thrombolysis with tPA in smokers.
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Affiliation(s)
- C. E. Kvistad
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| | - H. Oeygarden
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| | - N. Logallo
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| | - L. Thomassen
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| | | | - H. Naess
- Department of Neurology; Haukeland University Hospital; Bergen Norway
- Centre for Age-Related Medicine; Stavanger University Hospital; Stavanger Norway
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Tan NS, Goodman SG, Cantor WJ, Tan MK, Yan RT, Bagnall AJ, Mehta SR, Fitchett D, Strauss BH, Yan AT. Comparison of the efficacy of pharmacoinvasive management for ST-segment elevation myocardial infarction in smokers versus non-smokers (from the Trial of Routine Angioplasty and Stenting After Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction). Am J Cardiol 2014; 114:955-61. [PMID: 25118119 DOI: 10.1016/j.amjcard.2014.05.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/13/2014] [Accepted: 05/13/2014] [Indexed: 12/22/2022]
Abstract
Compared with non-smokers, cigarette smokers with ST-segment elevation myocardial infarctions derive greater benefit from fibrinolytic therapy. However, it is not known whether the optimal treatment strategy after fibrinolysis differs on the basis of smoking status. The Trial of Routine Angioplasty and Stenting After Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI) randomized patients with ST-segment elevation myocardial infarctions to a routine early invasive (pharmacoinvasive) versus a standard (early transfer only for rescue percutaneous coronary intervention or delayed angiography) strategy after fibrinolysis. The efficacy of these strategies was compared in 1,051 patients on the basis of their smoking status. Treatment heterogeneity was assessed between smokers and non-smokers, and multivariable analysis was performed to evaluate for an interaction between smoking status and treatment strategy after adjusting for baseline Global Registry of Acute Coronary Events (GRACE) risk score. Smokers (n=448) were younger, had fewer cardiovascular risk factors, and had lower GRACE risk scores. They had a lower rate of the primary composite end point of 30-day mortality, reinfarction, recurrent ischemia, heart failure, or cardiogenic shock and fewer deaths or reinfarctions at 6 months and 1 year. Smoking status was not a significant predictor of either primary or secondary end points in multivariable analysis. Pharmacoinvasive management reduced the primary end point compared with standard therapy in smokers (7.7% vs 13.6%, p=0.04) and non-smokers (13.1% vs 19.7%, p=0.03). Smoking status did not modify treatment effect on any measured outcomes (p>0.10 for all). In conclusion, compared with non-smokers, current smokers receiving either standard or early invasive management of ST-segment elevation myocardial infarction after fibrinolysis have more favorable outcomes, which is likely attributable to their better baseline risk profile. The beneficial treatment effect of a pharmacoinvasive strategy is consistent in smokers and non-smokers.
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Gupta T, Kolte D, Khera S, Aronow WS, Palaniswamy C, Mujib M, Jain D, Sule S, Ahmed A, Iwai S, Eugenio P, Lessner S, Frishman WH, Panza JA, Fonarow GC. Relation of smoking status to outcomes after cardiopulmonary resuscitation for in-hospital cardiac arrest. Am J Cardiol 2014; 114:169-74. [PMID: 24878124 DOI: 10.1016/j.amjcard.2014.04.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/15/2014] [Accepted: 04/15/2014] [Indexed: 10/25/2022]
Abstract
In-hospital cardiac arrest (IHCA) is common and is associated with poor prognosis. Data on the effect of smoking on outcomes after IHCA are limited. We analyzed the Nationwide Inpatient Sample databases from 2003 to 2011 for all patients aged≥18 years who underwent cardiopulmonary resuscitation (CPR) for IHCA to examine the differences in survival to hospital discharge and neurologic status between smokers and nonsmokers. Of the 838,464 patients with CPR for IHCA, 116,569 patients (13.9%) were smokers. Smokers were more likely to be younger, Caucasian, and male. They had a greater prevalence of dyslipidemia, coronary artery disease, hypertension, chronic pulmonary disease, obesity, and peripheral vascular disease. Atrial fibrillation, heart failure, and diabetes mellitus with complications were less prevalent in smokers. Smokers were more likely to have a primary diagnosis of acute myocardial infarction (14.8% vs 9.1%, p<0.001) and ventricular tachycardia or ventricular fibrillation as the initial cardiac arrest rhythm (24.3% vs 20.5%, p<0.001). Smokers had a higher rate of survival to hospital discharge compared with nonsmokers (28.2% vs 24.1%, adjusted odds ratio 1.06, 95% confidence interval 1.05 to 1.08, p<0.001). Smokers were less likely to have a poor neurologic status after IHCA compared with nonsmokers (3.5% vs 3.9%, adjusted odds ratio 0.92, 95% confidence interval 0.89 to 0.95, p<0.001). In conclusion, among patients aged ≥18 years who underwent CPR for IHCA, we observed a higher rate of survival in smokers than nonsmokers-consistent with the "smoker's paradox." Smokers were also less likely to have a poor neurologic status after IHCA.
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Impact of smoking status in patients with non-ST-segment elevation myocardial infarction: the reverse smoker's paradox. JACC Cardiovasc Interv 2014; 7:380-1. [PMID: 24742943 DOI: 10.1016/j.jcin.2013.12.197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 12/11/2013] [Accepted: 12/20/2013] [Indexed: 11/21/2022]
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De Luca G, Parodi G, Sciagrà R, Bellandi B, Comito V, Vergara R, Migliorini A, Valenti R, Antoniucci D. Smoking and infarct size among STEMI patients undergoing primary angioplasty. Atherosclerosis 2014; 233:145-8. [PMID: 24529135 DOI: 10.1016/j.atherosclerosis.2013.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 11/30/2013] [Accepted: 12/08/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prior studies have found that smokers with STEMI have lower mortality rates and a more favorable response to fibrinolytic therapy than nonsmokers, phenomenon defined as "the smoker's paradox". Still poorly explored is the impact of cigarette smoking in patients undergoing primary percutaneous coronary intervention. Aim of the current study was to evaluate the impact of cigarette smoking on scintigraphic infarct size in STEMI patients undergoing primary PCI. METHODS Our population is represented by 830 STEMI patients undergoing primary PCI. Infarct size was evaluated at 30 days by technetium-99m-sestamibi. RESULTS Smoking was associated with younger age (p < 0.001), a lower prevalence of female gender (p < 0.001), hypertension (p < 0.001), diabetes (p = 0.003), shorter ischemia time (p = 0.037), but higher rates of previous PCI (p = 0.016). No differences were observed in other clinical or angiographic characteristics. In particular, smoking did not affect the rate of postprocedural TIMI 3 flow. As shown in Fig. 1, smoking did not affect infarct size (12.5% [3.3%-23.7%] vs 12.7% [4.9%-25.9%], p = 0.12). Similar results were observed in subanalyses according to infarct location (anterior STEMI, p int = 0.33), gender (p int = 0.95) age, (p Int = 0.96), diabetes (p int = 0.85). The absence of any impact of smoking on infarct size was confirmed after correction for baseline characteristics, such as age, gender, hypertension, diabetes, previous PCI, ischemia time (OR [95% CI] = 0.80 [0.59-1.09], p = 0.15). CONCLUSIONS This study shows that among STEMI patients undergoing primary PCI smoking status does not affect infarct size.
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Affiliation(s)
- Giuseppe De Luca
- Division of Cardiology, "Maggiore della Carità" Hospital, Eastern Piedmont University, Novara, Italy.
| | - Guido Parodi
- Division of Cardiology Careggi Hospital, Florence, Italy
| | - Roberto Sciagrà
- Nuclear Medicine Unity, University of Florence, Florence, Italy
| | | | | | - Ruben Vergara
- Division of Cardiology Careggi Hospital, Florence, Italy
| | | | - Renato Valenti
- Division of Cardiology Careggi Hospital, Florence, Italy
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Meseguer E, Labreuche J, Gonzalez-Valcarcel J, Sirimarco G, Guidoux C, Cabrejo L, Lavallee PC, Klein IF, Amarenco P, Mazighi M. The smoking paradox: impact of smoking on recanalization in the setting of intra-arterial thrombolysis. Cerebrovasc Dis Extra 2014; 4:84-91. [PMID: 24926305 PMCID: PMC4035683 DOI: 10.1159/000357218] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 11/12/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The smoking paradox refers to a better outcome in smokers eligible for thrombolytic treatment in myocardial infarction or ischemic stroke. Recent findings suggest that current smokers may present higher recanalization rates after intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (rt-PA). We evaluated the impact of smoking in a consecutive series of patients treated with intra-arterial (IA) rt-PA. METHODS We analyzed data collected between April 2007 and December 2012 in our prospective registry. All acute ischemic stroke patients with an arterial occlusion treated by IA rt-PA (± IV, ± thrombectomy) were included. Arterial status was monitored with conventional angiography during the IA procedure. The primary study outcome was a complete recanalization achieved immediately after termination of IA rt-PA infusion. Secondary outcomes included complete recanalization after the end of the endovascular therapy (including complete recanalization achieved after adjunctive thrombectomy), favorable outcome (90-day modified Rankin Score ≤2), 90-day all-cause mortality, and any intracerebral hemorrhage. RESULTS Among the 227 included patients, 18.5% (n = 42) were current smokers and 16.7% (n = 38) former smokers. Compared with nonsmokers, current smokers were younger, more often men, had less frequently hypertension, and cardioembolic etiology, whereas former smokers were more often men and had more frequently hypercholesterolemia. The rate of complete recanalization was 30% (n = 68) after IA rt-PA infusion and 49% after adjunctive thrombectomy. A higher complete recanalization rate was found both in current smokers (45.2%) and former smokers (42.1%) compared to nonsmokers (22.5%). After adjustment for potential confounders, the adjusted odds ratio (OR) for complete recanalization associated with ever-smokers was 2.51 [95% confidence interval (CI) 1.26-4.99; p = 0.009]. A similar adjusted OR was found when the complete recanalization achieved after thrombectomy was included (OR 2.18, 95% CI 1.13-4.19; p = 0.019). However, smoking status was not independently associated with favorable outcome (adjusted OR 1.41, 95% CI 0.62-3.22 for former smokers, and adjusted OR 1.35, 95% CI 0.59-3.05 for current smokers), 90-day all-cause mortality (adjusted OR 0.68, 95% CI 0.25-1.81 for former smokers, and adjusted OR 1.55, 95% CI 0.54-4.48 for current smokers) or intracerebral hemorrhage (adjusted OR 0.72, 95% CI 0.29-1.76 for former smokers, and adjusted OR 0.80, 95% CI 0.32-1.96 for current smokers). CONCLUSIONS IA rt-PA administration was more effective to achieve complete arterial recanalization in current as well as former smokers. The characterization of the smoking paradox pathophysiology may lead to the identification of a patient-target population with a favorable response to rt-PA therapy. However, the smoking paradox should not be misinterpreted and not be used to promote smoking.
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Affiliation(s)
- Elena Meseguer
- Department of Neurology and Stroke Centre, Paris, France
- INSERM U-698 and Paris-Diderot University, Paris, France
| | | | - Jaime Gonzalez-Valcarcel
- Department of Neurology and Stroke Centre, Paris, France
- INSERM U-698 and Paris-Diderot University, Paris, France
| | - Gaia Sirimarco
- Department of Neurology and Stroke Centre, Paris, France
- INSERM U-698 and Paris-Diderot University, Paris, France
| | - Céline Guidoux
- Department of Neurology and Stroke Centre, Paris, France
- INSERM U-698 and Paris-Diderot University, Paris, France
| | - Lucie Cabrejo
- Department of Neurology and Stroke Centre, Paris, France
- INSERM U-698 and Paris-Diderot University, Paris, France
| | - Philippa C. Lavallee
- Department of Neurology and Stroke Centre, Paris, France
- INSERM U-698 and Paris-Diderot University, Paris, France
| | - Isabelle F. Klein
- Department of Radiology, Bichat University Hospital, Paris, France
- INSERM U-698 and Paris-Diderot University, Paris, France
| | - Pierre Amarenco
- Department of Neurology and Stroke Centre, Paris, France
- INSERM U-698 and Paris-Diderot University, Paris, France
| | - Mikaël Mazighi
- Department of Neurology and Stroke Centre, Paris, France
- INSERM U-698 and Paris-Diderot University, Paris, France
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Shen L, Peterson ED, Li S, Thomas L, Alexander K, Xian Y, Wang TY, Roe MT, He B, Shah BR. The association between smoking and long-term outcomes after non-ST-segment elevation myocardial infarction in older patients. Am Heart J 2013; 166:1056-62. [PMID: 24268221 DOI: 10.1016/j.ahj.2013.09.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 09/23/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Prior studies have observed that smokers have paradoxically favorable 1-year mortality rates after acute coronary syndromes, but it is unknown whether this association extends to long-term outcomes and to older patients. METHODS We identified 38,628 patients aged ≥65 years participating in the CRUSADE Registry between February 2003 and December 2006 with non-ST-segment elevation myocardial infarction and linked these patients to Medicare claims data to assess longitudinal outcomes. Cox proportional hazard models were used to examine the association between smoking, 30-day, and long-term outcomes. RESULTS Overall, 4,876 (13%) were current/recent smokers and 33,752 (87%) were nonsmokers. Compared with nonsmokers, smokers were younger and more likely to be male and to receive in-hospital revascularization (all P < .001) but less likely to have hypertension, diabetes mellitus, and renal insufficiency. Compared with nonsmokers, the unadjusted 30-day mortality was lower (8.7% vs 10.3%, P = .0004), but the adjusted 30-day mortality was similar (adjusted hazard ratio [HR] 1.08, 95% CI 0.97-1.20). Over a median of 3.6 years of follow-up, smokers had lower crude long-term mortality rates (53% vs 55% at 6 years, P = .001) but significantly higher long-term mortality rates after adjustment (adjusted HR 1.28, 95% CI 1.21-1.34). Smokers also had higher risks of all-cause readmission (HR 1.13, 95% CI 1.09-1.17) and recurrent myocardial infarction (HR 1.23, 95% CI 1.13-1.34). CONCLUSIONS Among older non-ST-segment elevation myocardial infarction patients, we found that smokers had significantly higher long-term risks for both mortality and recurrent myocardial infarction. These results support ongoing efforts to promote smoking cessation, even among older patients.
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Li YH, Lin GM, Lai CP, Lin CL, Wang JH. The “smoker's paradox” in Asian versus non-Asian patients with percutaneous coronary intervention longer than 6 months follow-up: A collaborative meta-analysis with the ET-CHD registry. Int J Cardiol 2013; 168:4544-8. [DOI: 10.1016/j.ijcard.2013.06.093] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 06/30/2013] [Indexed: 02/05/2023]
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Pollock JS, Hollenbeck RD, Wang L, Janz DR, Rice TW, McPherson JA. A history of smoking is associated with improved survival in patients treated with mild therapeutic hypothermia following cardiac arrest. Resuscitation 2013; 85:99-103. [PMID: 24036406 DOI: 10.1016/j.resuscitation.2013.08.275] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 08/26/2013] [Accepted: 08/30/2013] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To assess the association between smoking and survival with a good neurologic outcome in patients following cardiac arrest treated with mild therapeutic hypothermia (TH). METHODS We conducted a retrospective observational study of a prospectively collected cohort of 188 consecutive patients following cardiac arrest treated with TH between May 2007 and January 2012. Smoking status was retrospectively collected via chart review and was classified as "ever" or "never". Primary endpoint was survival to hospital discharge with a good neurologic outcome and was compared between smokers and nonsmokers. Logistic regression analysis was used to assess the association between smoking status and neurologic outcome at hospital discharge; adjusting for age, initial rhythm, time to return of spontaneous circulation (ROSC), bystander CPR, and time to initiation of TH. RESULTS Smokers were significantly more likely to survive to hospital discharge with good neurologic outcome compared to nonsmokers (50% vs. 28%, p=0.003). After adjusting for age, initial rhythm, time to ROSC, bystander CPR, and time to initiation of TH, a history of smoking was associated with increased odds of survival to hospital discharge with good neurologic outcome (OR 3.54, 95% CI 1.41-8.84, p=0.007). CONCLUSIONS Smoking is associated with improved survival with good neurologic outcome in patients following cardiac arrest. We hypothesize that our findings reflect global ischemic conditioning caused by smoking.
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Affiliation(s)
- Jeremy S Pollock
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Ryan D Hollenbeck
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Li Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - David R Janz
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Todd W Rice
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - John A McPherson
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
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Allahwala UK, Murphy JC, Nelson GIC, Bhindi R. Absence of a 'smoker's paradox' in field triaged ST-elevation myocardial infarction patients undergoing percutaneous coronary intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2013; 14:213-7. [PMID: 23856073 DOI: 10.1016/j.carrev.2013.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 05/25/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The 'smoker's paradox' refers to the observation of favorable prognosis in current smokers following an acute myocardial infarction (AMI). Initial positive findings were in the era of fibrinolysis, with more contemporary studies finding conflicting results. We sought to determine the presence of a 'smoker's paradox' in a cohort of ST Elevation Myocardial Infarction (STEMI) patients identified via field triage, treated with primary percutaneous coronary intervention (pPCI). METHODS This was a single center retrospective cohort study identifying consecutive STEMI patients presenting for pPCI via field triage. The primary end points were all cause mortality, major adverse cardiac events (MACE), major bleeding, in-hospital cardiac arrest and length of stay (LOS). RESULTS A total of 382 patients were included in the study. Current smokers were more likely to be younger (p<0.00001), male (p<0.001) and have fewer comorbidities, including renal impairment (p<0.01) and a history of AMI (p<0.05). Current smokers also had a shorter ischemic time (p<0.05), were less likely to have collateral circulation (p<0.05), and more likely to have signs of pulmonary edema at presentation (p<0.05). There was no difference between smoking groups and all cause mortality (p=0.67), MACE (p=0.49), major bleeding (p=0.49) or in-hospital cardiac arrest (p=0.43). Current smokers had a shorter LOS (p<0.05). In multivariate analysis smoking status did not correlate with primary outcomes. CONCLUSION The 'smoker's paradox' does not appear to be relevant among STEMI patients undergoing pPCI, identified via field triage. The previously documented 'smoker's paradox' may have been an indication of patient characteristics and the historical treatment of STEMI with thrombolysis. Further studies with larger numbers may be warranted.
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Affiliation(s)
- Usaid K Allahwala
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia.
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Ali SF, Smith EE, Bhatt DL, Fonarow GC, Schwamm LH. Paradoxical association of smoking with in-hospital mortality among patients admitted with acute ischemic stroke. J Am Heart Assoc 2013; 2:e000171. [PMID: 23782919 PMCID: PMC3698779 DOI: 10.1161/jaha.113.000171] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Compared to those who never smoked, a paradoxical effect of smoking on reducing mortality in patients admitted with myocardial ischemia has been reported. We sought to determine if this effect was present in patients hospitalized with ischemic stroke. METHODS AND RESULTS Using the local Get with the Guidelines-Stroke registry, we analyzed 4305 consecutively admitted ischemic stroke patients (March 2002-December 2011). The sample was divided into smokers versus nonsmokers. The main outcome of interest was the overall inpatient mortality. Compared to nonsmokers, tobacco smokers were younger, more frequently male and presented with fewer stroke risk factors such as hypertension, hyperlipidemia, diabetes, coronary artery disease, and atrial fibrillation. Smokers also had a lower average NIH Stroke Scale (NIHSS) and fewer received tissue plasminogen activator (tPA). Patients in both groups had similar adherence to early antithrombotics, dysphagia screening prior to oral intake, and deep vein thrombosis (DVT) prophylaxis. Smoking was associated with lower all-cause in-hospital mortality (6.6% versus 12.4%; unadjusted OR 0.46; CI [0.34 to 0.63]; P<0.001). In multivariable analysis, adjusted for age, gender, ethnicity, hypertension, diabetes mellitus, hyperlipidemia, CAD, atrial fibrillation, NIHSS, and tPA, smoking remained independently associated with lower mortality (adjusted OR 0.64; CI [0.42 to 0.96]; P=0.03). CONCLUSIONS Similar to myocardial ischemia, smoking was independently associated with lower inpatient mortality in acute ischemic stroke. This effect may be due to tobacco-induced changes in cerebrovascular vasoreactivity, or may be due in part to residual confounding. Larger, multicenter studies are needed to confirm the finding and the effect on 30-day and 1-year mortality.
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Affiliation(s)
- Syed F Ali
- Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA
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Physical activity, by enhancing parasympathetic tone and activating the cholinergic anti-inflammatory pathway, is a therapeutic strategy to restrain chronic inflammation and prevent many chronic diseases. Med Hypotheses 2013; 80:548-52. [DOI: 10.1016/j.mehy.2013.01.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 01/13/2013] [Indexed: 12/22/2022]
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Rakowski T, Siudak Z, Dziewierz A, Dubiel JS, Dudek D. Impact of smoking status on outcome in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. J Thromb Thrombolysis 2013; 34:397-403. [PMID: 22773074 PMCID: PMC3459076 DOI: 10.1007/s11239-012-0764-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There are some data showing lower mortality of smokers comparing to non-smokers in patients with ST-segment elevation myocardial infarction (STEMI) when treated with thrombolysis or without reperfusion therapy. However, the role of smoking status is less established in patients with STEMI undergoing mechanical reperfusion. We evaluate the influence of smoking on outcome in patients with STEMI treated with primary percutaneous coronary intervention (PCI). A total of 1,086 patients enrolled into EUROTRANSFER Registry were included into present analysis. Patients were divided according to smoking status during STEMI presentation into those who were current smokers (391 patients, 36 %) and non-smokers (695 patients, 64 %). Current smokers were younger and more often men and less frequently had high-risk features as previous myocardial infarction, history of chronic renal failure, previous PCI, diabetes mellitus, anterior wall STEMI, and multivessel disease. Unadjusted mortality at 1 year was lower in current smokers comparing to non-smokers (3.3 vs. 9.5 %; OR 0.33 CI 0.18–0.6; p = 0.0001). However, after adjustment for age and gender by logistic regression, there was no longer significant difference between groups (OR 0.7; CI 0.37–1.36; p = 0.30). In conclusion, current smokers with STEMI treated with primary PCI have lower mortality at 1 year comparing to non-smokers, but this result may be explained by differences in baseline characteristics and not by smoking status itself. Current smokers developed STEMI more than 10 years earlier than non-smokers with similar age and sex-adjusted risk of death at 1 year. These results emphasize the role of efforts to encourage smoking cessation as prevention of myocardial infarction.
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Affiliation(s)
- Tomasz Rakowski
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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